Currently I am combo feeding my 10 week old LO due to feeding issues since birth. I tried desperately to make things work so that I could exclusively breastfeed, but it has not yet worked out. I exclusively BF for the first four weeks, but she started to become lethargic and was not gaining weight so along with the help of a lactation consultant I made the choice to supplement with formula. I was not able to pump enough to satisfy baby’s hunger and am still not able to do so, so we continue to use formula after nursing if she is still hungry. I think we’re about 60/40 breastmilk to formula. However, I have been trying very hard to increase my supply (it was never fully established) and fix our feeding issues so that I can cut out the formula completely. I have contacted my local LLL volunteers, doctors, multiple lactation consultants and everyone says something different.

I’ve tried to troubleshoot multiple possibilities, but now that I’m more familiar with various breastfeeding issues, I’m wondering if my LO has a clampdown bite reflex. Here are some of the things that made me wonder if this is it:
- White line on nipple after nursing – since birth
- Squirmy baby (even when my breasts are full) i.e. pulling away from breast, arching back during feedings even when I hear her swallowing the milk.
- From outward appearance, baby looks properly latched (and was checked by multiple LCs at the hospital). And, I’ve done everything to try and stop baby from creasing the nipple during latch on. This has been true since birth.
- Sporadic swallowing (very rarely getting more than five minutes of swallowing rhythm.
- Constantly have to compress breasts during nursing to get a flow that baby will accept.
- Recurring plugged ducts (every other day if I don't carefully compress during pumping and nursing), mastitis twice.
- Low supply even when nursing full time, pumping after feedings, extra pumping, taking fenugreek, taking lecithin, etc. Immediately after a feeding I can pump up to an ounce from each breast, whereas pumping without a feeding I can produce 2 -3 ounces. I believe that baby is just not emptying breasts.

If it is the bite reflex, how do we solve this issue? I have to go back to work October 1st. My fear is that when I go back I will have to give daycare formula since I can't nurse her - and I don't pump enough milk to give them my milk to feed her. I really think my supply would be fine if we could figure out how to get baby to stop clamping. Has anyone else experienced this and how did you make it work?

September 5th, 2012, 02:33 PM

@llli*mommal

Re: we're still struggling at 10 weeks - clampdown bite refl

Welcome to the forum!

When babies clamp down, they're ussually doing it for a reason. And that reason is usually that the flow of milk is too fast for them, and they need to slow it down. Clamping down is like crimping a straw. Compress the nipple, and the flow slows down (and a white line, ridge, or crease is created by the compression). When a baby clamps down due to flow speed issues, there is usually an underlying cause for the fast flow issue, and that is usually milk oversupply. And when there's a milk oversupply, babies tend to gain weight very quickly and mom generally will have little trouble meeting baby's needs when pumping. Because your baby has struggled in the weight gain department and you have been forced to supplement with formula, I think it is unlikely that your baby is clamping down for the usual flow speed reason.

So if the clamping isn't a response to a fast letdown, what is causing it? The three possibilities that spring to my mind are 1, that baby is tongue-tied and cannot obtain a deep latch, or 2, that baby loses her latch over the course of the feeding as she becomes tired and the breast drags down on her little mouth, or 3, that something like reflux is making her uncomfortable and leading to her trying to eat less when nursing.

All that being said, I am not sure that your issues aren't being caused by fast letdowns and oversupply! Your pumping output is normal; most women make about 1.5 oz of milk per hour when supply is well-matched to demand. You mention that your breasts do get full, and that really only happens when baby takes less milk than mom is making. You've had mastitis twice and recurrent plugged ducts, and those two conditions are often associated with oversupply, though they can also be caused by a poor latch.

I would see another LC, preferably an IBCLC, for a hands-on evaluation of the possibilities above.

A couple questions for you:
- Clamping- does it happen primarily at the end of the feeding, or is it present throughout?
- Pain- are you experiencing any and if so, when do you feel the most pain? When baby first latches on, or towards the end of the feeding?
- How often does baby nurse?
- How much supplement do you offer after nursing?
- What sort of pump are you using?

September 5th, 2012, 06:32 PM

@llli*ramatae

Re: we're still struggling at 10 weeks - clampdown bite refl

I never would have considered oversupply. The only time I feel truly "full" is in the middle of the night when I haven't nursed for four hours. During the day, I don't feel that way as she is nursing so often. What is normal for pumping output after a feeding vs. no feed? Just now I nursed first and then was able to pump .75 from one side and .25 oz from the other. In the middle of the night if she hasn't fed I get on a good day 2.75 to 3 oz and on a typical day 2 oz. When I pump, I normally only see one stream during let-down.

In response to your questions:

1. The clamping is consistent throughout the feeding.
2. It's not really painful, more like pinching. the pinch is hardest upon latch and of course if she squirms and pulls then it is painful. I thought she was pulling when the flow stopped or was slow.
3. She nurses every hour to hour and a half, except for at night (she sleeps through). Honestly, I sit in the rocker with her all day holding her, so she is in my arms almost constantly until my husband gets home. When she nurses, I can hear her gulping at the start of a feeding and then one of two things will happen. Her suck/swallow pattern slows down (within 15 minutes) but she stays on the breast to suckle and sleep. She will continue to suckle for about an hour before she pulls off. The other thing that happens is she gets frustrated (when this happens I can't hear the swallowing) and pulls away as though nothing is coming out. This is when I supplement.
4. I offer either expressed breastmilk or formula only after I've nursed and she's still acting hungry. I offer a 2 oz bottle. Sometimes she takes an ounce, sometimes the whole bottle.
5. I use the Medela pump in style advanced.

September 5th, 2012, 07:05 PM

@llli*mommal

Re: we're still struggling at 10 weeks - clampdown bite refl

Normal pumping output is about 1.5 oz per hour when pumping in place of nursing, though not all moms are capable of getting that much. A mom's expertise with the pump, her responsiveness to pumping, the make and model of her pump, the wear level of her pump, the time of day at which she pumps, when she last nursed- all those factors and more can influence how much a mom produces when pumping. Getting an ounce of milk after nursing is actually quite normal, and better than many moms get.

Clamping that is consistent throughout the feeding sounds like a latch problem that is independent of supply (clamping in response to oversupply usually occurs several minutes into the feeding, as the letdown is occurring, or at the end of the feeding when the baby no longer wants milk but wishes to continue to suck). It sounds more like tongue tie or just the consequence of having a very young baby with a very small mouth. It's good that the pinching is just pinching- latch issues can cause excruciating pain. I think you're on the right track about the squirming. Many babies pull, unlatch, or fuss when the flow slows down.

Your baby's nursing frequency sounds normal except for the sleeping all the way through the night. Many 10 week old babies are still nursing every few hours at night, and if mom is lucky the baby will sleep one 5-6 hour stretch. Since you feel like you're having issues with supply, I'd wake baby 1-2 times at night to nurse. Night nursing is great for supply!

I have a feeling that you do not need to be supplementing. Everything your baby is doing is pretty normal, and not an indication of low supply. The supplements are probably shooting you in the foot to a certain extent; every time you react to baby's pulling off and fussing by offering a bottle, you're teaching her that she doesn't need to work for her milk. She just needs to fuss and you'll give her the bottle. I suggest trying to make her a little more businesslike at the breast by taking her off the breast when she either falls asleep or transitions to lazy comfort nursing, and switching her to the other side. Switch nursing is really good for supply, it gets baby fed somewhat faster, and it usually reduces the need for supplements. However, having switch nursing work for you is predicated on the assumption that baby has a good, effective latch. The compression/clamping you're experiencing makes me a little nervous about that- which is why I strongly suggest making a second appointment with an LC.

September 5th, 2012, 08:51 PM

@llli*ramatae

Re: we're still struggling at 10 weeks - clampdown bite refl

I should clarify - when I say sleeping through the night, I still feed her at 3am. The stretch she sleeps is normally 4-5 hours, rarely 6.

I agree that I probably don't have a supply problem (or at least wouldn't have a supply problem). During the day I am switch feeding her to try to avoid supplementation. I'm just concerned since this (the nipple pinching and the fussing and pulling at the breast) has been occurring since birth. In the first four weeks when we were EBF, we would switch feed her all day and night, but eventually she would scream, kick, and flail herself to sleep - which I know now was hunger. By one month she had dropped below 5th percentile on the breastfed babies chart and that's when the LCs and our ped told us to supplement with expressed milk or formula. This is the same exact behavior she has now, but the difference is when she screams and kicks and flails, I feed her the supplement. That's also why after I've fed one side and then the other, and back again, I allow her to sleep at the breast, because I know if I keep waking her to switch, she will scream in hunger. Whereas, when I allow her to sleep after/during the feeding, she takes less of the supplement and I have letdowns throughout the time she's suckling. I know it's not ideal to supplement and that it will eventually ruin my supply - but I'm afraid the nipple pinching truly is limiting the transfer of the milk so she's not getting what she needs without it.

I've purchased an SNS system and will continue to try and use that to avoid the use of bottles, but since I have to wash it after every use I'm not able to use it frequently. I will also try to find a LLL consultant rather than the hospital LCs. I've seen three separate LCs at the hospital already (I had been going to a group) and none were able to help me solve this issue. They said she was not tongue tied, but didn't mention anything about a small mouth. They told me I had a low supply (which I believe was true because of baby's inability to transfer milk...but it's not true anymore with all the pumping and herbs, etc I'm doing to keep it up). Now that I have an established supply but she's still acting the same, I just don't know how to fix the issue since I've followed all of the advice I've been given so far.

Since baby is so tense (even at the beginning of a feeding her legs and feet are flexed and jaw is tight whether fed from bottle or breast) I just wonder if there's something I'm missing. For instance, is this all related to labor and birth (vacuum extraction)? I was hoping there might be moms on the forum with similar stories that might help me clue in to the underlying cause or share what worked for them.

Thank you so very much for your input, talking it through really helps and keeps me motivated.